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Niewiem M, Grzybowska-Chlebowczyk U. Assessment of Selected Intestinal Permeability Markers in Children with Food Allergy Depending on the Type and Severity of Clinical Symptoms. Nutrients 2022; 14:nu14204385. [PMID: 36297068 PMCID: PMC9608842 DOI: 10.3390/nu14204385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Food allergy (FA) has a broad range of symptoms, and clinical manifestations may concern several reactions from one system or organ. Aim: The aim of the study was to assess intestinal permeability (IP) based on the analysis of serum zonulin and bacterial lipopolysaccharides (LPS) levels in children with FA, taking into account the pathomechanism of immune reaction, clinical symptoms of FA and their severity. Material and methods: The study comprised 103 patients aged 7–60 months (median 34); 49 children with IgE-mediated allergy and 25 children with non-IgE-mediated allergy; the reference group comprised 29 children with functional gastrointestinal disorders. IP markers were determined using ELISA. Results: There was no correlation between the severity of clinical symptoms and the level of IP markers in children with FA. Zonulin and LPS levels were significantly higher in children with FA and gastrointestinal symptoms. Zonulin levels in the subgroup of children with non-IgE-mediated FA and gastrointestinal symptoms were significantly higher than in the subgroup of children with IgE-mediated FA and these symptoms. The level of LPS was significantly higher in the subgroup with IgE-mediated FA and atopic dermatitis. Conclusions: Zonulin and LPS levels were significantly higher in children with FA compared to children from the reference group. Zonulin levels were significantly higher in children with non-IgE-mediated FA than in children with IgE-mediated FA.
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Connor F, Salvatore S, D’Auria E, Baldassarre ME, Acunzo M, Di Bella G, Farella I, Sestito S, Pensabene L. Cows' Milk Allergy-Associated Constipation: When to Look for It? A Narrative Review. Nutrients 2022; 14:1317. [PMID: 35334974 PMCID: PMC8955686 DOI: 10.3390/nu14061317] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/02/2022] [Accepted: 03/17/2022] [Indexed: 12/11/2022] Open
Abstract
Constipation is a very common disorder, mostly functional in nature, that may persist for years in up to 35-52% of children. Food allergy prevalence, severity and persistence are increasing over time, and cows' milk protein is the commonest food allergen recognised to affect gastrointestinal motility in children. There is mounting evidence of the role of cows' milk (CM) allergy (CMA) in children with constipation. With this narrative review, we aim to provide clinicians with an updated and critical overview of food allergy-associated constipation. We searched Embase, Medline and the Cochrane Library, using keywords related to the topic. Only reviews and studies including children aged 0-17 years that were published in English were considered. Constipation has been reported in 4.6% of infants with CMA; the prevalence of food allergy underlying chronic constipation in children resistant to conventional treatment and presenting to tertiary clinics ranges between 28% and 78%. The identification of predisposing risk factors and of a specific phenotype of food allergy-induced constipation remains elusive. No allergic tests, radiological or motility investigations achieve sufficient sensitivity and specificity to screen children for CMA-related constipation. A 4-week cows' milk protein (CMP) elimination diet may be considered for children with chronic constipation resistant to conventional treatment and who lack alarm sign/symptoms of organic diseases. In subjects with ameliorated symptoms on CMP elimination, the diagnosis of CMA should be confirmed by a food challenge to avoid an unnecessary protracted diet.
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Affiliation(s)
- Frances Connor
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children’s Hospital, Brisbane 4101, Australia;
- Mayne Academy of Pediatrics, Faculty of Medicine, University of Queensland, Brisbane 4101, Australia
| | - Silvia Salvatore
- Department of Pediatrics, Ospedale “F. Del Ponte”, University of Insubria, 21100 Varese, Italy; (S.S.); (G.D.B.)
| | - Enza D’Auria
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (E.D.); (M.A.)
| | - Maria Elisabetta Baldassarre
- Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Unit, “Aldo Moro” University of Bari, 70124 Bari, Italy;
| | - Miriam Acunzo
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (E.D.); (M.A.)
| | - Gaia Di Bella
- Department of Pediatrics, Ospedale “F. Del Ponte”, University of Insubria, 21100 Varese, Italy; (S.S.); (G.D.B.)
| | - Ilaria Farella
- Department of Biomedical Science and Human Oncology, Clinica Medica “A. Murri”, “Aldo Moro” University of Bari, 70124 Bari, Italy;
| | - Simona Sestito
- Department of Medical and Surgical Sciences, Pediatric Unit, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
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Webb C, Zwick D. Food protein-induced enterocolitis syndrome, an uncommonly encountered pathologic entity. HUMAN PATHOLOGY: CASE REPORTS 2019. [DOI: 10.1016/j.ehpc.2019.200325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Does milk cause constipation? A crossover dietary trial. Nutrients 2013; 5:253-66. [PMID: 23340316 PMCID: PMC3571647 DOI: 10.3390/nu5010253] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 11/26/2012] [Accepted: 12/20/2012] [Indexed: 11/25/2022] Open
Abstract
The aims of this study were to: (1) determine whether replacement of cow’s milk protein with soy resolves Chronic Functional Constipation (CFC); and (2) investigate the effects of cow’s milk β casein A1 and cow’s milk β casein A2 on CFC. Children diagnosed with CFC were recruited to one of two crossover trials: Trial 1 compared the effects of cow’s milk and soy milk; Trial 2 compared the effects of cow’s milk β casein A1 and cow’s milk β casein A2. Resolution of constipation was defined as greater than eight bowel motions during a two week intervention. Thirteen children (18 to 144 months) participated in Trial 1 (6 boys, 7 girls). Nine participants who completed the soy epoch all experienced resolution (p < 0.05). Thirty-nine children (21 to 144 months) participated in Trial 2 (25 boys, 14 girls). Resolution of constipation was highest during the washout epoch, 81%; followed by cow’s milk β casein A2, 79%; and cow’s milk β casein A1, 57%; however, the proportions did not differ statistically. The results of Trial 1 demonstrate an association between CFC and cow’s milk consumption but Trial 2 failed to show an effect from type of casein. Some other component in cow’s milk common to both A1 and A2 milk may be causing a problem in these susceptible children.
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CROWLEY ET, WILLIAMS LT, BROWN LJ. How do mothers juggle the special dietary needs of one child while feeding the family? A qualitative exploration. Nutr Diet 2012. [DOI: 10.1111/j.1747-0080.2012.01604.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Friedl J. Lactase deficiency: Distribution, associated problems, and implications for nutritional policy. Ecol Food Nutr 2010. [DOI: 10.1080/03670244.1981.9990654] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vieira MC, Morais MB, Spolidoro JVN, Toporovski MS, Cardoso AL, Araujo GTB, Nudelman V, Fonseca MCM. A survey on clinical presentation and nutritional status of infants with suspected cow' milk allergy. BMC Pediatr 2010; 10:25. [PMID: 20416046 PMCID: PMC2873518 DOI: 10.1186/1471-2431-10-25] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Accepted: 04/23/2010] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cow's milk is the most common food allergen in infants and the diagnosis of cow's milk allergy is difficult, even with the use of several diagnostic tests. Therefore, elimination diets and challenge tests are essential for the diagnosis and treatment of this disorder. The aim of this study is to report the clinical presentation and nutritional status of children evaluated by pediatric gastroenterologists for the assessment of symptoms suggestive of cow's milk allergy. METHODS An observational cross-sectional study was performed among 9,478 patients evaluated by 30 pediatric gastroenterologists for 40 days in 5 different geographical regions in Brazil. Clinical data were collected from patients with symptoms suggestive of cow's milk allergy. The nutritional status of infants (age < or = 24 months) seen for the first time was evaluated according to z-scores for weight-for-age, weight-for-height, and height-for-age. Epi-Info (CDC-NCHS, 2000) software was used to calculate z-scores. RESULTS The prevalence of suspected cow's milk allergy in the study population was 5.4% (513/9,478), and the incidence was 2.2% (211/9,478). Among 159 infants seen at first evaluation, 15.1% presented with a low weight-for-age z score (< -2.0 standard deviation - SD), 8.7% with a low weight-for-height z score (< -2.0 SD), and 23.9% with a low height-for-age z score (< -2.0 SD). CONCLUSION The high prevalence of nutritional deficits among infants with symptoms suggestive of cow's milk allergy indicates that effective elimination diets should be prescribed to control allergy symptoms and to prevent or treat malnutrition.
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Affiliation(s)
- Mário C Vieira
- Centre for Paediatric Gastroenterology, Hospital Pequeno Príncipe, R. Desembargador Motta, 1070, Curitiba-PR 80250-060, Brazil
| | - Mauro B Morais
- Department of Paediatrics, Universidade Federal de São Paulo, R. Botucatu, 598, São Paulo-SP 04023-062, Brazil
| | - José VN Spolidoro
- Department of Paediatrics - School of Medicine, Pontifícia Universidade Católica, Av. Ipiranga, 6690, Porto Alegre-RS 90610-000, Brazil
| | - Mauro S Toporovski
- Department of Paediatrics - School of Medicine, Santa Casa de São Paulo, R. Cesário Motta Jr., 112 São Paulo-SP 01221-020 Brazil
| | - Ary L Cardoso
- Department of Paediatrics, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho Aguiar, 647, São Paulo - SP 05403-000, Brazil
| | - Gabriela TB Araujo
- Health Economics, Axia.bio Consulting, R. Setembrino Woitechumas, 38/4, São Paulo-SP 04563-090, Brazil
| | - Victor Nudelman
- Department of Paediatrics, Hospital Albert Einstein, Av. Albert Eisntein, 627, São Paulo - SP 05651-901, Brazil
| | - Marcelo CM Fonseca
- Health Economics, Axia.bio Consulting, R. Setembrino Woitechumas, 38/4, São Paulo-SP 04563-090, Brazil
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CROWLEY E, WILLIAMS L, ROBERTS T, JONES P, DUNSTAN R. Evidence for a role of cow's milk consumption in chronic functional constipation in children: Systematic review of the literature from 1980 to 2006. Nutr Diet 2008. [DOI: 10.1111/j.1747-0080.2007.00225.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Opinion of the Scientific Panel on Dietetic products, nutrition and allergies [NDA] on a request from the Commission relating to the evaluation of allergenic foods for labelling purposes. EFSA J 2004. [DOI: 10.2903/j.efsa.2004.32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Daher S, Tahan S, Solé D, Naspitz CK, Da Silva Patrício FR, Neto UF, De Morais MB. Cow's milk protein intolerance and chronic constipation in children. Pediatr Allergy Immunol 2001; 12:339-42. [PMID: 11846872 DOI: 10.1034/j.1399-3038.2001.0o057.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cow's milk protein (CMP) allergy was investigated in 25 children (age-range 3 months to 11 years) with chronic constipation. A diagnosis of constipation was made on the basis of a history of painful elimination of hard stools for at least 1 month, whether or not associated with a reduced frequency of stools or soiling. The children were evaluated using clinical parameters and the following laboratory tests: total serum immunoglobulin E (IgE); specific IgE (radioallergosorbent test [RAST]) for whole cow's milk, alpha-lactoalbumin, beta-lactoglobulin, and a food group; and skin-prick tests with whole milk, alpha-lactoalbumin, beta-lactoglobulin, and casein. Following the evaluation, the children were submitted to a CMP-free diet for a period of 4 weeks. In seven patients (28%), constipation disappeared during the CMP-free diet and reappeared within 48-72 h following challenge with cow's milk. In two infants a rectal biopsy revealed allergic colitis and they therefore did not undergo the challenge. High serum levels of total IgE were observed in five of the children who showed a clinical improvement (71%), a positive skin-test in two (29%), and detectable specific IgE in two (29%). These results suggest that CMP allergy or intolerance should be considered as a cause of chronic refractory constipation in children, although the underlying mechanism still require further investigation.
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Affiliation(s)
- S Daher
- Divisions of Allergy, Clinical Immunology and Rheumatology, UNIFESP - EPM, São Paulo, SP, Brazil.
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Abstract
Fecal soiling is common in childhood and can be caused by stool toileting refusal, fecal incontinence due to organic disease, or encopresis due to functional constipation. Anatomical, neurologic, and inflammatory causes for fecal soiling are ruled out by history and physical examination and, if necessary, by anorectal manometry, barium enema, and rectal biopsy. The initial treatment suggestion for children with stool toileting refusal is to put the child back into pull-ups or diapers. Most children with fecal soiling due to organic disease continue with some degree of incontinence despite optimal medical management. Antegrade enema administration helps those with severe fecal incontinence due to organic causes who do not respond to medical management. Successful treatment of constipation and encopresis requires a combination of medical therapy, nutritional intervention, behavioral intervention, and long-term compliance with laxative use. The combined treatment approach improves the constipation and encopresis in all patients who comply with the treatment program. In some children, cow's milk protein intolerance may be the cause. In them, cow's milk protein needs to be eliminated.
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Affiliation(s)
- E Brigino
- Division of Allergy and Immunology, All Children's Hospital, University of South Florida, Saint Petersburg 33701, USA
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Forsyth BW, McCarthy PL, Leventhal JM. Problems of early infancy, formula changes, and mothers' beliefs about their infants. J Pediatr 1985; 106:1012-7. [PMID: 3998939 DOI: 10.1016/s0022-3476(85)80260-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Problems of early infancy are sometimes managed by changing an infant's formula from a cow milk formula to a soy protein or casein hydrolysate formula ("special formulas"). This study was designed to determine the frequency of formula changes, mothers' reports of problems that lead to such a change, and mothers' beliefs about the causes of these problems. Mothers of 189 breast-feeding (BF) and 184 formula-feeding (FF) infants were enrolled postpartum. Follow-up data were obtained by telephone interviews at 4 months. After starting a cow milk formula, 11% of the BF and 25% of the FF infants were given special formulas. Mothers frequently reported problems related to feeding, bowel movements, and crying behavior; 32% of infants with such problems were given special formulas. Excessive crying and colic were the most common problems leading to a formula change. When a formula was changed, mothers more frequently believed that the cause of the problem was intrinsic to the child (P less than 0.001) and that their infant had had a "disease or illness" (P less than 0.001). When formula changes occurred, 26% of mothers believed that their infants were allergic to cow milk. These beliefs may affect a mother's perceptions of her child's vulnerability.
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Abstract
Recent advances in the accessibility of the bowel and in techniques for the study of colonic pathology have resulted in descriptions of several forms of colitis which were previously unrecognized and in elucidation of the etiology of previously described but poorly understood entities. Present knowledge of antibiotic-associated colitis, colitis indeterminate, acute self-limited colitis, collagenous colitis and the colitis of food allergy is reviewed.
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Gerrard JW. Allergies in breastfed babies to foods ingested by the mother. CLINICAL REVIEWS IN ALLERGY 1984; 2:143-9. [PMID: 6428733 DOI: 10.1007/bf02991062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Chin KC, Tarlow MJ, Allfree AJ. Allergy to cows' milk presenting as chronic constipation. BMJ : BRITISH MEDICAL JOURNAL 1983; 287:1593. [PMID: 6416515 PMCID: PMC1549769 DOI: 10.1136/bmj.287.6405.1593] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Halpern GM. Clinical-immunologic correlates: a state-of-the-art review and update. Alimentary allergy. J Asthma 1983; 20:251-84. [PMID: 6194146 DOI: 10.3109/02770908309077085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Crawford LV, Herrod HG. Allergy diets for infants and children. CURRENT PROBLEMS IN PEDIATRICS 1981; 11:1-44. [PMID: 7318497 DOI: 10.1016/0045-9380(81)90023-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Verkasalo M, Kuitunen P, Savilahti E, Tiilikainen A. Changing pattern of cow's milk intolerance. An analysis of the occurrence and clinical course in the 60s and mid-70s. ACTA PAEDIATRICA SCANDINAVICA 1981; 70:289-95. [PMID: 7195640 DOI: 10.1111/j.1651-2227.1981.tb16554.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The rapid changeover to commercial adapted infant formulae which took place in Finland between 1973 and 1975 was studied as a factor in the occurrence of severe intestinal cow's milk intolerance (CMI). Of infants treated for CMI in 1962-73, ninety-three percent (25/27) were on homemade or unadapted formulae. The admission rate for CMI in these years was 0.22/1 000 liveborn infants breast fed less than six months. During 1974-77 the corresponding figure was 0.56, with 85% of the patients (18/26) on adapted cow's milk formulae. The patients treated before 1974 had a longer symptomatic period before admission, greater growth retardation and more severe intestinal damage than those seen during and after 1974. This is believed to reflect mainly the increasing awareness of CMI on the part of both laymen and the medical profession. In the history of 2/3 of the patients at least one of the following conditions was noted: non-breast feeding, infectious gastroenteritis, praematurity, 21-trisomy, prior intra-abdominal surgery, Hirschsprung's disease, and atopic disease in family members. The long follow-up averaging over four years revealed four patients with coeliac disease. In one of these the proximal jejunal mucosa was normal after two years on gluten-containing diet, but he showed a mucosal relapse as late as between 2 to 4 years on normal diet.
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Abstract
AbstractSoy‐based formulas and meat‐based formulas are used as successful replacements for milk in the nutritional management of infants who are, or are suspected to be allergic to milk. Used most widely are soy‐based formulas which eliminate the symptoms and ensure normal growth and well being of the infant. Soy‐based formulas are made in both powdered and liquid forms, and the trend during the past decade has been to use a soy protein isolate to reduce or eliminate the presence of carbohydrates which cause flatulence and abnormal stooling. Details of the nutritional composition of soy‐based infant formulas are discussed together with the selection and processing of protein in order to minimize the presence of antinutritional factors.
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Harris MJ, Petts V, Penny R. Cow's milk allergy as a cause of infantile colic: immunofluorescent studies on jejunal mucosa. AUSTRALIAN PAEDIATRIC JOURNAL 1977; 13:276-81. [PMID: 350216 DOI: 10.1111/j.1440-1754.1977.tb01162.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
A girl with the syndrome of thrombocytopenia with absent radius had severe diarrhoea and dehydration relieved by withdrawal of cows' milk and aggravated by its reintroduction on three occasions. Deterioration in gastrointestinal symptoms was associated with haematological relapse with thrombocytopenia, leucocytosis, anaemia, and eosinophilia. There appeared to be a correlation between milk exposure and the haematological and gastrointestinal disturbances. Supporting evidence from published reports for such a correlation is reviewed. Cows' milk protein intolerance may be a factor in precipitating haematological relapse in susceptible infants with radius aplasia. Early withdrawal of cow's milk protein should be tried in thrombocytopenia with absent radius, especially in cases with prominent gastrointestinal upset.
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Freier S, Kletter B. Clinical and immunological aspects of milk protein intolerance. AUSTRALIAN PAEDIATRIC JOURNAL 1972; 8:140-6. [PMID: 4264597 DOI: 10.1111/j.1440-1754.1972.tb01807.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
Milk allergy can be overcome easily if one develops a high index of suspicion which leads to early diagnosis. Avail able treatments make the outcome uniformly successful.
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VAUGHAN VC. Allergic problems in the upper respiratory tract, including the ear. Pediatr Clin North Am 1957:285-91. [PMID: 13400573 DOI: 10.1016/s0031-3955(16)30487-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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